LRC Rock 'n Role Membership Class Registration
Please fill out this form and click submit.
Name
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Address
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Phone
*
Email
*
This address will receive a confirmation email
Date of Birth
*
Marital Status
*
Please select one option.
single
married
Spouse's Name (if applicable)
Children's Names & Birthdates (if applicable)
Choose one
*
Please select one option.
May 20 - Session #1
June 3 - Session #1
Choose one
*
Please select one option.
May 27-Session #2
June 10-Session #2
Occupation/Business
Skills/Hobbies
Church Background
How long have you been attending LRC?
*
What factors led to your interest in LRC and in joining the membership of LRC?
Who do you know best at LRC?
What was the name of your last church?
Are you a member of a previous church?
Please select one option.
Yes
No
In what areas have you served in the church?
Which describes you best?
*
Please select one option.
I am a convinced believer in Jesus as my Lord and Savior.
I am a believer in Jesus, but I have many doubts about my faith.
I am not yet a Christian, but I am searching.
Have you been baptized?
*
Please select one option.
Yes, I was baptized as an infant.
Yes, I was baptized as a child or adult.
No, I have not been baptized.
Select Option
Yes, I was baptized as an infant.
Yes, I was baptized as a child or adult.
No, I have not been baptized.
Do you believe the Bible is the inspired Word of God?
*
Please select one option.
Yes, I do.
No, for various reasons.
I am not sure.
Select Option
Yes, I do.
No, for various reasons.
I am not sure.
Do we have your permission to ask you about any difficulties you have experienced in a church setting? Please explain...
Are you a member of any club or society, which may be in conflict with the Scriptures or membership in LRC? (i.e. free masons, activist groups, etc.)
*
Please select all that apply.
yes
no
not sure
Submit
Description
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